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(Please Print)
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NAME:
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Last First Middle Maiden
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Present Address
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Number, Street, City, State, Zip
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How long Have You Been At Present Address:
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Social Security No.
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Telephone
Home:
Cell:
Email:
Best Time Of Day To Contact You:
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If under 18, please list age:
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Can you legally work in the United States?
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YES
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NO
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Position applying for?
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Salary Desired?
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Days/hours available to work?
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THURS
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No Pref
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FRI
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MON
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SAT
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TUES
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SUN
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WENS
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How many hours can you work weekly?
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Employment desired:
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FULL-TIME ONLY
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FULL- OR PART-TIME
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PART-TIME ONLY
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TYPE OF SCHOOL NAME OF SCHOOL LOCATION NUMBER OF YEARS COM. MAJOR &
DEGREE
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HIGH SCHOOL OR
GED
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COLLEGE
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BUS. OR TRADE SCHOOL
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PROFESSIONAL SCHOOL
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HAVE YOU EVER BEEN CONVICTED OF A CRIME?
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YES
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NO
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If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how
recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
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Please list two references other than relatives or previous employers.
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Name
Position
Company
Address
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Name
Position
Company
Address
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Name of previous Employer
Address
Phone Number
Name of last supervisor
Employment dates
Hourly or salary
Starting pay
Final pay
Your last job title
Reason for leaving
(be specific)
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Hourly
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Salary
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List the jobs you held, duties performed, skills used or learned,
advancements or promotions while you worked at this company.
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In a few short sentences tell us why we should hire you and
what makes you so unique as an individual.
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PLEASE READ CAREFULLY AND
CHECK BOXES AT BOTTOM
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Authorization to
Release Information
I have applied for a position with Kennett Oil,
Kennett River City Marathon, Kennett Truck Stop,
Aurora Farm and Garden (companies).
I have been requested to provide information for
their use in reviewing my background and
qualifications. Therefore, I hereby authorize the
investigation of my past and present work,
character, education, military and employment
qualifications.
The release in any manner of all information by you
is hereby authorized whether such information is of
record or not, and I do hereby release all persons,
agencies, firms, companies, etc., from any
damages resulting from providing such
information.
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Consent for Drug/Alcohol Screen Testing
If you are offered and accept employment with
Kennett Oil, Kennett River City Marathon,
Kennett Truck Stop, Aurora Farm and Garden
(companies), in the interest of safety for all
concerned, you might be selected at any time
before or during employment to take a test for
drug and/or alcohol use.
By clicking YES in the check box, you have been
fully informed of the reason for this urine test for
drug and/or alcohol (I understand what I am
being tested for), the procedure involved, and
do hereby freely give my consent.
If this test is positive, and for this reason I am
not hired, I understand that I will be given the
opportunity to explain the results of this test.
I hereby authorize these test results to be
released to Kennett Oil, Kennett River City
Marathon, Kennett Truck Stop, Aurora Farm and
Garden.
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Yes I am consenting to
this Authorization to
Release form
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Yes I am consenting to a
drug and or alcohol test
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No I am not consenting
to this Authorization to
release form
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No I am not consenting to
a drug and or alcohol test
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